Governors push for ACA stabilization, more Medicaid innovation with healthcare reform blueprint

John Kasich speaking at lectern
John Kasich is one of five governors who have penned a blueprint for health reform. (www.governor.ohio.gov)

A bipartisan group of governors has released a blueprint for healthcare reform that builds on recommendations they released last year, even as federal-level efforts to repeal, replace or reform have stalled.

The blueprint (PDF) was written by Democrats John Hickenlooper of Colorado and Tom Wolf of Pennsylvania; Republicans John Kasich of Ohio and Brian Sandoval of Nevada; and independent Gov. Bill Walker of Alaska. In it, the five governors outline steps to guide health reform, including stabilizing the Affordable Care Act's individual marketplaces and allowing states the flexibility to improve their Medicaid programs. 

The bipartisan group signed onto a blueprint released in August that included some of the same provisions. Three more Democratic governors also backed that plan: Louisiana's John Bel Edwards, Montana's Steve Bullock and then-Virginia Gov. Terry McAuliffe. 

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To stabilize the exchanges, the governors recommend that the federal government fund cost-sharing reduction payments, increase outreach to encourage enrollment and stabilize risk pools through programs such as reinsurance. 

"Americans without access to employer-sponsored coverage or government plans need to have access to a healthy, stable and competitive market of insurers from which to choose," the governors wrote. 

RELATED: Special Report—8 ways to fix the Affordable Care Act 

Lawmakers from both sides of the aisle have been working on legislation to stabilize the ACA exchanges, but the process has been slow. A pair of bills, one crafted by Sens. Patty Murray, D-Mo., and Lamar Alexander, R-Tenn., and a second from Sen. Susan Collins, R-Maine, focuses on establishing a reinsurance program

Collins initially backed the Republicans' tax reform plan in December after Senate Majority Leader Mitch McConnell assured her an ACA stabilization measure would pass by the end of 2017. Alexander and Collins later asked McConnell to postpone ACA fixes, with Alexander promising a stabilization bill as a "Valentine's Day present." 

State officials, including Kasich and Hickenlooper, have been active in the ACA stabilization discussions, backing the Alexander-Murray measure. 

RELATED: Governors signal support for Medicaid expansion 

In addition to offering their take on how to stabilize the ACA exchanges, the governors pushed for expanded state innovation in Medicaid. This includes incorporating the social determinants of health better in Medicaid programs and using available data to measure and incentivize social programs. 

Their Medicaid plans did not address the potential for work requirements directly, but the governors called for states to have the ability to ensure low-income patients can access coverage, through financial incentives or expanding their Medicaid programs, while avoiding "perverse incentives." 

What exactly that means is likely to vary between the governors involved in the report—in Ohio, for example, officials have applied for a waiver to establish work requirements for its Medicaid program. Meanwhile, in Pennsylvania, Wolf vetoed a similar bill, The Morning Call reported.  

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